快速康复外科理念结合临床路径对复杂性肝内胆管结石患者术后康复效果的影响  

Effect of fast track surgery-clinical nursing pathways on postoperative rehabilitation of patients with complex intrahepatic bile duct stones

作　　者：张秋月 甄璐 徐南霞 ZHANG Qiuyue;ZHEN Lu;XU Nanxia(Department of Hepatobiliary Disease Diagnosis and Treatment Center,Nanyang First People's Hospital,Nanyang,Henan 473000,China)

机构地区：[1]南阳市第一人民医院肝胆病诊疗中心外科,河南南阳473000

出　　处：《社区医学杂志》2024年第18期637-641,共5页Journal Of Community Medicine

摘　　要：目的探讨快速康复外科理念结合临床路径(FTS-CNP)对复杂性肝内胆管结石(CIHBDS)患者腹腔镜胆管切开取石术后康复效果的影响。方法选取南阳市第一人民医院2021-05-01-2022-05-31收治的92例CIHBDS患者作为研究对象,随机数字表法分为常规组(46例)和FTS-CNP组(46例),2组患者均行腹腔镜胆管切开取石术,常规组采用常规的围手术期临床路径护理干预,FTS-CNP组采用FTS-CNP模式的护理干预。比较2组患者康复进程、术后3 d疼痛程度[视觉模拟评分法(VAS)评分]、并发症发生情况、心理状态[焦虑自评量表(HAMA)、抑郁自评量表(HAMD)评分]及护理工作满意度。结果FTS-CNP组首次排气时间为(6.20±1.04)h,短于常规组的(11.92±1.89)h,首次进食时间为(6.87±1.05)h,短于常规组的(12.35±2.78)h,首次下床时间为(5.21±0.93)h,短于常规组的(10.95±1.71)h,住院时间为(6.89±1.32)d,短于常规组的(9.26±2.10)d,差异有统计学意义,t值分别为17.984、12.507、20.000和6.344,均P<0.001;术后3 d,FTS-CNP组疼痛程度明显轻于常规组(Z=4.309,P<0.001);FTS-CNP组并发症发生率(4.35%)低于常规组(21.74%),χ^(2)=6.133,P=0.013;护理后,FTS-CNP组HAMA评分为(8.11±2.49)分,低于常规组的(10.78±2.71)分,HAMD评分为(9.74±2.57)分,低于常规组的(11.22±2.81)分,差异有统计学意义,F值分别为17.330和3.895,P值分别为<0.001和0.024;FTS-CNP组护理工作满意度(93.48%)高于常规组(76.09%),χ^(2)=5.392,P=0.020。结论FTS-CNP护理干预可加快CIHBDS患者腹腔镜胆管切开取石术康复进程,减轻患者术后的疼痛程度,调节负性心理状态,还能减少并发症的发生,提升护理满意度。Objective To investigate the effect of fast track surgery-clinical nursing pathways(FTS-CNP)on the rehabilitation of patients with complex intrahepatic bile duct stones(CIHBDS)undergoing laparoscopic cholangiolithotomy.Methods A total of 92CIHBDS patients admitted to Nanyang First People's Hospital from May 1,2021to May 31,2022 were selected and divided into routine group(46cases)and FTS-CNP group(46cases)by random number table method.Laparoscopic cholangiolithotomy was performed in both groups,and conventional group received routine perioperative clinical route nursing intervention.FTS-CNP group received FTS-CNP nursing intervention.The recovery process,postoperative pain degree[visual analogue scale(VAS)score],complication occurrence,psychological state[Hamilton anxiety scale(HAMA)and Hamilton depression scale(HAMD)score]and nursing satisfaction were compared between the two groups.Results The first exhaust time in the FTS-CNP group was(6.20±1.04)h,which was shorter than that in the conventional group(11.92±1.89)h;the first eating time was(6.87±1.05)h,shorter than that in the conventional group(12.35±2.78)h;the first ambulation time was(5.21±0.93)h,shorter than that in the conventional group(10.95±1.71)h;and the hospital stay was(6.89±1.32)d,shorter than that in the conventional group(9.26±2.10)d.The differences were statistically significant,with t-values of 17.984,12.507,20.000,and 6.344,respectively,all P<0.001.After3days of operation,the pain degree of FTS-CNP group was significantly less than that of conventional group(Z=4.309,P<0.001).The complication rate of FTS-CNP group(4.35%)was lower than that of conventional group(21.74%),χ^(2)=6.133,P=0.013.After nursing,the HAMA and HAMD scores in the FTS-CNP group were(8.11±2.49)points and(9.74±2.57)points,respectively,which were significantly lower than those in the conventional group(10.78±2.71)points and(11.22±2.81)points,and the differences were statistically significant(Fvalues were 17.330and 3.895,P values were<0.001and 0.024).The satisfaction

关 键 词：复杂性肝内胆管结石 快速康复外科理念 临床路径护理 腹腔镜胆管切开取石术 康复进程 

分 类 号：R473.6[医药卫生—护理学]